Original Authors (2020): Melanie Hecker, MPA; Karen Weigle, PhD; Alyce Benson, LCSW; Jeni Yielding, OTR/L
Revision (2025): Melanie Hecker, BA; Micah Peace Urquilla, BA; Karen Weigle, PhD; Jessica Kramer, PhD, OTR/L
Sensory processing is how a person detects and responds to stimuli in their environment and body. All people detect and manage sensory input in different ways, which shape people’s actions and behaviors in their environments. Patterns of sensory behaviors, such as hyperresponsiveness (e.g., sensitivity) or avoidance, can lead to problems with physical exams and the ability to interact with health care providers. These sensory patterns do not merely cause annoyance or discomfort, but can overwhelm a person, be painful, and make the person with IDD unable to function and/or follow requests. If a sensory trigger is present, a person with an IDD may not be able to focus on anything else like the words you say, your face, gestures, or other things in the environment. In some cases, exposure to sensory triggers can cause dysregulation, a sure sign that the person is in extreme distress.
It is especially important for prescribers and other office staff to explain or show (on someone else) each piece of equipment used and what it is going to do (blood pressure cuffs, thermometers, etc.) While these may seem like everyday items to some, they can cause increased stress and sensory arousal for a person with IDD.
Sensory triggers are unique to everyone, and different patients may have different combinations of triggers. One patient may be triggered by strong scents and flickering lights, while another may be triggered by high pitch sounds and scratchy clothes.
It is important to ask new patients what their sensory triggers are and how to avoid or mitigate them. Behavioral reactions to sensory stimuli are a manifestation of a person’s sensory patterns and needs and should not be understood or treated as a behavior that is extinguishable with medication, behavior plans, or exposure. If sensory triggers are causing significant interference with people’s daily lives and well-being, a referral and evaluation by a licensed occupational therapist can provide information the team can use to support successful engagement in health exams and other daily activities.
The following is a discussion of some common sensory triggers and how to accommodate them. Please note that a patient may have a sensory trigger that is not discussed here.
Visual
The most common visual sensory triggers involve lighting. Flickering, fluorescent, and strobing lights are all common visual triggers. Most fluorescent lights that bother a person with overreactive visual senses are not seen as bothersome to others (although the flickering is very subtle and recognizable to them). Bright, contrasting colors can also cause visual overstimulation.
Considerations: It is important to avoid fluorescent or strobe lighting in your practice and to quickly change any flickering light bulbs. The use of lamps or natural lighting is usually preferred. Using pastel or pale colors as opposed to bright colors to decorate your office can also help prevent visual triggers. Sometimes a lot of items in the room can cause visual sensory overload; fewer items and wall hangings are more calming. It is also suggested during medical checkups not to approach the person straight on from the front, which may cause much more anxiety and a fight or flight response. Approach from the side (e.g., for tongue depressor, light in nostril, palpate the neck, or listen to heart).
Audio
Loud or unexpected noises are the most common sound triggers. High-pitch, low-pitch, or repetitive noises can also be triggering. However, some sound triggers are unique to the person.
Considerations: It is important to quickly be able to turn off or turn down any music or television you may have playing in your practice. Remember that fluorescent lights also create a low humming noise that can be distracting for many people. Have a quiet, low sensory space in your practice set aside for patients who may need to leave an area due to the presence of a sound trigger. You may want to have a few pairs of noise-cancelling headphones (made of material that can be disinfected frequently) that patients may use while in the office. Also, if a procedure is going to produce a sound (even as common as a blood pressure cuff inflating/deflating), make sure to let the person know.
Tactile
There are many common tactile triggers. For many people with IDD, another person touching them is one such trigger. Other common tactile triggers involve clothing, ranging from scratchy or tight clothes to clothes with seams in them. The feeling of a certain object or material on a person’s hands or skin can also be a tactile trigger (latex, cotton swabs/balls, clay, or chalk). Food and medication textures can also be tactile triggers.
Considerations: To accommodate tactile triggers surrounding clothing, have hospital gowns and slippers on-hand that are not scratchy and do not have seams. You may also need to allow the person to leave their clothes on or wear only underclothes without a gown if hospital clothing cannot be tolerated. Also, have non-latex gloves available.
Sensory triggers involving being touched by another person can be difficult to address in a medical setting. Firm touch is usually tolerated better than light touch. Avoid touching a patient with IDD as much as possible and never touch the person without letting them know. Surprise can result in a startle response.
Considerations: In instances where touch cannot be avoided, a prescriber can briefly distract a patient by talking to them about their interests. “Priming” techniques can also be used to help the person better tolerate touch. An example is rubbing the arms or legs to “wake up” the sensory system and decrease the startle response to further touch. It is best if the provider directs the patient or their parent/support person (if present) to give themselves 5 firm self-hugs or squeeze clasped hands together 10 times. It is also helpful to tell the patient what you are doing and what to expect, so they are not surprised by any procedures and are better prepared for what is to come. Always let the person know you are going to touch them (“I’m going to touch your wrist to count your pulse.” or “I’m going to press around a little on your neck because I need to feel what is there.”).
Taste/Texture
Strong, bitter, sour, and salty tastes can all be sensory triggers. This can pose a problem for prescribers, as medication often has a strong bitter taste. Textures of foods, medications, and even liquids can be disturbing to some people, which again must be considered in the delivery method of prescription medications. Many people have strong gag reflexes to certain textures, which will keep them from being able to swallow.
Considerations: There are a few methods that prescribers can use to help mitigate taste triggers in medication. One approach is to fill the medication with a flavor coating. A prescriber can also recommend taking the medication with a flavored beverage such as fruit juice.
Taste and texture triggers may also prevent a person with IDD from eating certain foods, which may lead to nutritional issues. If nutrition becomes a problem for a patient with sensory triggers, it is important to work with them on a diet plan that allows them to obtain the nutrients they need while also avoiding foods that trigger them.
Considerations: The prescriber may make a referral to an occupational therapist, dietician, or nutritionist in the event of nutritional issues. One strategy these providers often use is called priming of the face/oral area. Massaging the masseter (chewing muscle) on the jaw area of the face and firmly clamping teeth together 10 times will often decrease an overreactive gag.
Interoception
Interoceptive sensory triggers are internal signals related to bodily sensation like hunger, thirst, temperature, or heart rate. For some people with IDD, interpreting and responding to these internal cues can be difficult or even distressing and can present some challenges in communicating internal states and sensations. People with IDD may be hyper- or hypo-responsive to pain or changes in temperature. The sensation of hunger may go unnoticed or may be experienced as nausea. Some may be sensitive to the sensation of thirst and prefer to always have a drink on hand. Office policies regarding food and drink should accommodate these needs. Like tactile triggers, people with IDD may be sensitive to sensations like the pressure of a blood pressure cuff, the cool touch of a stethoscope, or the sensation of having blood drawn or receiving an injection. The use of these tools and what a person might feel during use should be discussed thoroughly with the patient beforehand.
Considerations: Accommodating sensory differences in interoception requires thoughtful office policy and frequent, open conversation with patients regarding their internal experience. Office policies regarding food and drink should include reasonable accommodations for those who may be especially sensitive to these internal triggers, allowing them to keep food or drink on hand while waiting and attending appointments
Prescribers should discuss a patient’s baseline for these and other important internal cues like pain and note and discuss potential signs of departure from that baseline like irritability, body position, or facial expressions (i.e., hunching over, strained expressions.) Nearby restrooms should be clearly marked, well-maintained, and easily accessible. Prescribers should take care to discuss all potential side effects – not only common side effects – of medications with the patient and their caregiver (if present,) and carefully, continually assess a patient’s response to medications. Similarly, prescribers and other office staff such as nurses and assistants should carefully discuss their use of medical instruments like stethoscopes and blood pressure cuffs and prepare the patient for any sensations that may cause discomfort.
Proprioception
Proprioceptive sensory triggers impact a person’s sense of body position and movement, and can result in dizziness, disorientation, discomfort, and even anxiety in people with IDD. People with IDD may need more time or modeling for how to carry out certain movements, such as rolling over on an exam table or turning their head, to prevent dizziness or disorientation. It is important to tell a patient if you will be approaching or touching them to move a part of their body, such as positioning an arm for a blood draw or manipulating another part of it. Busy patterns on wallpaper or flooring, or hectic waiting rooms with a lot of movement can trigger proprioceptive responses for hypersensitive people with IDD.
Considerations: In instances where movement is required, provide more time and clear instruction or modeling for people with IDD to execute movement or motor-related activities. Ask and describe what you will do before moving or manipulating a part of someone’s body. Keep waiting and office areas as clean and spacious as possible; do not pack furniture or wall art closely together and avoid stripes or other busy patterns that may be triggering to some people. Include clear signage for where to go to check in, check out, and restrooms, as well as arrows or other signs that can help patients navigate office hallways.
Conclusion
Understanding sensory processing, and how it varies greatly among people, especially those with IDD, is fundamental to providing respectful and effective care. Sensory triggers can disrupt communication, overwhelm people, and fundamentally interfere with clinical care. By asking about a patient’s triggers, adapting the environment, explaining procedures in advance, and collaborating with occupational therapists when needed, providers can reduce distress and support meaningful participation. Adopting these strategies fosters a clinical setting in which patients with IDD can be heard, respected, and engaged rather than sidelined by sensory barriers.
Reference
- Dean EE, Little L, Tomchek S, Wallisch A, Dunn W. Prevalence models to support participation: Sensory patterns as a feature of all children’s humanity. Front Psychol. 2022; 13:875972. doi:10.3389/fpsyg.2022.875972
